about Depression

[thalassa]

Re: about Depression

I have never actually met a sewer rat so I don't know what sort of bedside manners they have. But most of the doctors I've met? They're fine. They're keeping me going.

I've had pretty good doctors too...military and civilian. Sure, a few were problematic, but the percentage of people that shouldn't be allowed to operate a motor vehicle on the highway greatly excedes the number of subpar physicians I've seen.

[Roknrol]

Re: about Depression

but I doubt the Drs abilities to diagnose and fix the problem, not the symptoms.

Ah...so you don't trust what science there is? I realize that psychological stuff is far more mysterious, even to science, than we would like. That's not my question.

I've known psychotics, manic depressives and ADD folks who are also into the Occult. They were ALL aware of their condition yet were also capable of dealing with, say the phantasms that appeared or a manic episode. They were able to use the power of their own Will to defeat the urges and feelings that were detrimental and false.

Then you've found a very small group of friends that either 1) were far stronger than the vast majority of the people on the planet or 2) they were bullshitting you, at least a bit. Virtually ALL of my friends when I was younger had some line of shit that they used to try to feed people. Otherwise intelligent people claiming lung cancer (and a miraculous recovery), assassins, members of the mob, sterile, psycho, manic depressive, ADHD, and there was even a girl that insisted that she was an "Indian Princess". A desire to fit in or attract attention *might* be a psychological disorder, as is hypochondria. But since you oppose the actual science I'm not sure how that could be determined.

I have an instinctive dislike of all Drs, for I think they are over-paid, over-rated, egomaniacal ingrates who don't have the bedside manner of a sewer rat.

What an outstanding blanket statement! I don't suppose you could back up the allegations with anything? No? Just an opinion? K.

They shove Big Pharm hyped non-AMA approved drugs

[citation needed]

into any poor bastard they can and use them for guinea pigs.

You obviously have zero idea of the restrictions that pharmaceutical companies have to operate under in order to have a medication approved for anything. My wife worked on a cancer drug some time ago - she gave the first human being the first does of the drug following the animal trials. She ended up being aware of the process as she was involved with other drugs by the time, but for something like CANCER, which is kinda something people are trying to cure in a hurry, took over 10 years for a drug with nearly zero side-effects to get approved for human consumption. Prior to that, the drugs are tested on sick people that have volunteered.

But I digress. I've only been forced to go to a Dr twice in 20 years as I always use herbs instead.

Then you are an exceptionally lucky individual, and I hope for your sake that your perspective doesn't kill you. See the whatstheharm link above.

I am not a dr, don't claim to be one but I know what works and as far as how well all that diagnosing goes, GIGO(garbage in, garbage out).

Erm...you "know" what works and what doesn't, huh? Cool - care to help me cure my impotence? Hey, my wife has Plantar Faschitis...what herb will fix that? My son got bit on the face by a dog when he was younger - would you have preferred a seamstress or a hospital (we chose the hospital, not realizing that we had other options)? What do you recommend for things like heart attacks and strokes?

Yes, there ARE "bad" doctors. There are awful people in every field that are more than happy to capitalize on someone else's pain. I hardly think that indicates the entire field is flawed.

Drs don't see people any more,

This part, at least, is correct. It is quite a major issue in the medical field - and one that I can actually explain quite coherently if you're interested in listening. The short version is that while there are some bad doctors that are contributing to the problem, the problem is about 90% created by lawyers and legal issues due to politicians catering to those that have ulterior motives. The long version is below.

they only see numbers and symptoms which they try to rule out the endless possibilities before giving you some thing to try to fix it.

Some of them, maybe. The doctors that my wife and I have worked with over the years, nosomuch. Doctors frequently lament the fact that they can't spend more time with patients, so much so that there are actually fewer students in Medical School because the students think that the environment that they have to operate under is so toxic that they can't do any good.

Of course, they're wrong. Any time you can spare 30 seconds to try to help someone you've done some good. Maybe not enough, but some.

So why is the environment so toxic? Well, I'll explain that - but I do want to mention that these problems are very very similar to the problems that are currently being created in various technical fields. I suppose if we can find an unexploited job market we could do the same and make billions. That being said, the problem goes something like this (this isn't 100%, as few things are, but it is a huge piece of the puzzle).

Ok, so you have Joe Doctor putting himself through medical school. Let's assume that this pre-med student's parents aren't independently wealthy, so even though his grades have allowed him to become accepted to medical school, he still has his bills, rent, etc - just like the rest of the world (btw, this also goes some way toward explaining why rich people become doctors. Hint: it's much simpler than a conspiracy). So he works his ass off for 12-16 years, starting the same way everyone else does, on the bottom, trying to do too much with too little time and not enough energy to do it. And he finishes Medical School, and then he becomes...

A resident, where he gets to make between $40 and $50k a year to have the exact same responsibilities as an actual doctor making 10 times that amount. So yes, he gets the 24/7 on-call (after all, if you have a Resident working for you, he should get all of the mucky jobs, being bottom of the totem pole). And after ALL of this - you're talking somewhere in excess of 20 years of training, the doctor gets to address his student loans and all of the other debt he accumulated while he was learning (see, rich people have an easier time with this). In the end, his student loans will be somewhere in the ballpark of $300k and up. Keep in mind that if the doctor has wanted to have any sort of a personal life between the ages of 18 and 38 they have probably accrued quite a bit more debt - families, mortgages, etc...just like the rest of us.

Medical malpractice used to be a major cost for doctors up until about 2010 I guess - while doing the research for this post I stumbled across some new information (kind of a long read, but actually explains better some of what I'm talking about here) - http://truecostofhealthcare.org/malpractice

So huge loans, huge debt, 20+ years of an inability to climb any sort of corporate ladder and improve their financial situation, at which point they get to start paying for all of this shit (all the while having to fork over more dough to be able to stay relevant in their field and have the best information available for their patients. While this may seem altruistic, it's actually required by the AMA in order for the doctor to keep his/her license. This means more student loans and more bills. Rinse, repeat. Just like the rest of us, only with vastly larger numbers.)

Ok, so in a different direction, to address your other concern, we talk about the doctor to patient ratio. I wholeheartedly agree - it sucks in most cities. We had a doctor in Las Vegas - a very good doctor, one that insisted he spend a realistic amount of time with each patient to understand and try to fix their problem. The result? He still had to pay staff and bills, so he couldn't exactly cut back on his patient load. Besides, he wanted to HELP people, and you can't do that if you turn people away. So the end result was that you had to schedule an appointment 2 months in advance to see a GP, where unless you were lucky enough to have the very first appointment of the day you were likely to be in the waiting room until early evening. Blame the doctor if you want, but he doesn't make an hourly wage. If he works 16 hours in a day he gets paid the same amount as if he works 4 hours a day all other things being equal.

The result from this has been less than stellar (although again, I can hardly find fault with the doctors for this). So let's say you're a doctor and you have 5 patients a day, which is a nice number because it gives you the right amount of time with each patient. And they like you. They like your bedside manner and they like the fact that you always try to find the root cause rather than treating symptoms. You are the apparently-impossible "good doctor". Uh oh. You're becoming popular with the locals. Your name is getting out there because you're such a good doctor, more and more patients are trying to come to see you. So what do you do? Find another doctor? Do you have the space in your office (after all, at this point you're basically a business owner on top of everything else, so you get to deal with all of THOSE logistical headaches too...not enough offices? Computers? Beds? You're screwed)? Do you have the money to be able to get someone in and train them up? These are all additional costs, all from the doctor trying to help the patient. So he looks around, and realizes that the field of medicine is actually pretty sparse. You have to find someone specifically in your field too - it doesn't do you any good to hire a plastic surgeon as a top notch pediatrician, as they would have to go through vast amounts of retraining to get there - and this process itself is next to impossible.

So what next? I can't get more doctors...what do I do next? Well, my nursing staff is really helpful and they save me a lot of time (doublechecking my work, assisting with patients, getting information that doesn't require my involvement), so maybe I should get some more nurses?

But see, nurses make quite a bit of money too. They don't have a lot of the overhead costs that doctors do, true enough, but they also can't prescribe medication or diagnose patients. So here I am, overworked, understaffed, and despite the evidence, underpaid.

And that all happens before some stupid twat sues you because she trips over her own toddler in the waiting room. And what happens if you're unlucky enough to be a doctor who gets a wrongful suit filed? http://www.kevinmd.com/blog/2013/03/...itigation.html It's a career ending event. Half a million dollars in loans down the tubes, your entire family and life relying on you making that kind of money, and now your career is over.

Are there bad doctors? Yes. There are bad doctors just like there are bad pilots and bad waitresses. When you come up with a way to make sure everyone does their job perfectly, you will have solved the world. And yes, mistakes do get made - they ARE human beings, after all. Are the mistakes understandable? Sometimes. Sometimes there's confusion caused by other staff members, sometimes you just space out. It shouldn't happen, but it does - to everyone. A medical degree, no matter how much it costs or how much money it generates, makes someone not human.

All of the above ignores the overall topic, being psychological doctors rather than the medical sort (your statements were unclear, and I assumed the latter rather than the former).

In the field of psychology things ARE more fuzzy. They are less certain. There is less known. Of course, those doctors get paid significantly less money, as well.

No, I don't have a problem with "doctors" in the least (specific doctors, yes, but not as a whole). I think the primary problem with psychological problems is that unless you have experienced it, you can't understand it. I remember when I was dealing with depression (oh so many years ago) and my therapist freaked out when I told him I was suicidal 5+ days a week. He couldn't even comprehend the idea, much less why I was still sitting in front of him. And his lack of experience prevented him from being able to help me as much as he wanted. Sometimes the value of a therapist is in allowing you the opportunity to explore your own problems and draw realistic conclusions. Sometimes. Other times, medication is absolutely necessary and you should see a psychologist - schizophrenia is very very VERY real, and the medications frequently DO work.

Now it's time for me to agree with you, and to explain why I felt this lengthy missive was warranted anyway.

I "cured" my depression by "getting over it". I solved my problem by "being strong" and by "not listening to the urges". I'm inclined to agree that the majority of psychological conditions aren't new (although I differ with you on this, as I actually think that they are real disorders) and are only recently being identified. Of course, other "disorders" are dropping off of that list just as fast - being gay is no longer a mental disorder. That's good. I'm also inclined to agree that some doctors may not have your best interests in mind, and that some medications seem to create more problems than they cure...but that all depends on how strongly you feel about it. I was put on medications for my depression for a few years. Not only did none of them work (for me), but they made me feel worse. So I stopped taking them. On the other hand, my sister had very good luck with similar medications, and I know we have quite a few very intelligent and aware members here that have had similar results. In the absence of evidence supporting your statement that the drugs don't work, anecdotal evidence would suggest otherwise.

But there was far far more to it than that. Reducing a lengthy, complicated process - one which your own brain actively tries to prevent you from completing - to a few rude comments insults everyone that has ever had to deal with a real psychological condition. That's like saying, "Oh, well, if you want to build a car from the ground up, you start with a frame, wheels, engine, and seats - it's that simple!". It's not that simple. It's never that simple. Our brains are very complicated pieces of machinery for which we have no owners' manual.

Background: You said you're not a doctor. I'm not either. My wife is a research nurse (primarily in Cancer research, but she has worked on many other studies as well) and has been for over 10 years. I have many close friends that are doctors, having worked for them before (for some reason, Radiologists seem to like computer guys quite a bit...it seems to be an anomaly, as most other doctors are confused by me). So no, I don't have first hand experience with some of what I've talked about, but I've been a lot closer than most.

While you can decide to never see a doctor, as you obviously have, for those of us that aren't fortunate enough to have immunities to viruses and broken bones can help our doctors make informed decisions about our treatment(s). It's not easy, but it helps.
1) consider your symptoms: Think about what symptoms you are experiencing, and what symptoms may be "exaggerated" in your head. Telling the doctor that you've been vomiting and not informing them that you've had horrible stomach cramps for 3 days restricts their ability to help. Also, be realistic about the pain you are experiencing and your thresholds. Exaggerating for expediency may seem like a good idea, but it can lead to some very wrong conclusions.
2) realistically research the medications: Everyone tells you not to do this - that the simple act of reading the side-effects can cause you to experience them. While this is technically true, remember that one of the side effects of Aspirin is death. Understanding that when 1 in 1 million people has gotten a headache from the medication can go some way to preventing you from assuming that you're "one in a million".
3) get 2nd and 3rd opinions: It's a Free country. If you don't like a doctor, find another. If you think he/she's giving you bad advice, go elsewhere. There are few places in the US that are limited to one sole physician...you might have to drive further, or you might have other inconveniences. Why should this be different than anything else that you pay for?
4) research research research: Did you go to see your doctor and get diagnosed with a rare and difficult-to-diagnose disorder? Was it something that you can see? (a tumor, for example, or something that would show up on an X-ray?) Obviously, we aren't doctors, but if a doctor is telling me there's a mass in my lung, that will show up on an X-ray. And that X-ray is mine, so I can take it to another doctor and have him/her look at the exact same picture and tell me what they think.

And probably the most important point,

5) Understand the doctor's job. They are not magicians. They are not Gods. They are troubleshooters of the most complicated machine on the planet. Machines that are so amazing we have only been able to discover a fraction of what they're capable of. And they have been trained by people that also don't have a complete understanding of the machine. But if people dismissed what they didn't understand we would still be following herds and living in mud huts, or worse, we'd still be in the trees.

[Juniper]

Re: about Depression

Warwulf will not be returning to this thread or the forum in general. Move along and be respectful to each other.

[Roknrol]

Re: about Depression

Ok, if there was a post that's been deleted I would be thoroughly grateful if I could see it. I got his little temper tantrum in my mailbox, so expected something like this, but now I'm f'ing curious as to what else took place

[Quetzal]

Re: about Depression

He was just swearing you all out, calling you posers and homophobic terms. Entertaining, but nothing worth wasting time on.

OT: As someone who's been on anti-depressants for a while now, I can resolutely, without any doubts say that 60% of the time, anti-depressants work all the time.
Anyway, I don't really have any coping mechanism outside of that, I just become the living dead until the wave of depression wears itself down. I've pretty much come to terms with the whole thing as part of me, so while it does halt my life sometimes, I never get suicidal or anything anymore. World's gonna keep on spinning whether I want it to or not.

[MaskedOne]

Re: about Depression

Juni will be back on later today, Rok. I'll forward the request to her. That's all I'm inclined to promise at this point in time.

[Roknrol]

Re: about Depression

Juni will be back on later today, Rok. I'll forward the request to her. That's all I'm inclined to promise at this point in time.

It's all good...based on what Quetzal said it sounds much like the same as the PM he sent me.

I will admit...I sent him an email through his profile to gloat, so that should be fun if we ever hear back.

Yes, I'm bad. Remember, I was the first Troll allowed here

[Heka]

That was my mother he was talking about.



Damn.

[thalassa]

Re: about Depression

Here's the thing -- everything was premised on the chemical theory of depression, which has been repeated so often that it is taken as fact. It isn't. The chemical theory of depression is like having a blood theory of scabs. http://link.springer.com/article/10..../fulltext.html, for what it's worth.

There are some huge problems with that paper. It would take much more time than I have to go point by point to point out the flaws in some of the conclusions of the authors (am at work on my coffee time), but suffice to say that they have an overly simplistic view of things going on. That tends to be a problem with meta-studies sometimes, one has to be careful about how they used different studies information bundled together. Also, the author failed to account for complexity in his persuit of his agenda. Don't get me wrong, he has some great points too, particularly with regards to the criticism to media reporting about depression and the problem of bias in science funding...but this is a problem with media reporting of just about everything, but particularly science (and health issues as part of science) reporting, also science funding isn't always a conspiracy (don't get me wrong, it can be).





Depression (and other mental disorders) are incredibly complex. The brain is incredibly complex. There are a ton of things that we know, and even more that we don't--about brain chemistry and the myriad of chemicals (from neurotransmitters to hormones and everything else) working in the brain, about how different regions of the brain (even on a neruon-to-neuron level) interact, about how genetics affects brain development and chemistry, about how the environment and external factors (everything from stress levels to envrionmental pollutants) affect brain chemistry, about how brain chemistry affects brain structure and development, etc.

People often complain that psych meds don't help them...well, yeah, because psych meds are geared to a handful of neurotransmitters (NT) that we understand--upstream and downstream there are dozens and dozens of other chemicals and chemical interactions to factor in. Plus, some of those neurotransmitters primarily work because they (over time) affect the physical structure of the brain--something that takes weeks or months to respond to the brain chemistry changes. The effect of something like Prozac takes about 4-6 weeks to feel and people expect them to work as soon as they start taking them--but its not on/off like that (plus, for some, the side-effects are prohibitive). And, just because we address brain chemistry issues, doesn't mean everything is magically fine and we can then ignore things like stress levels or diet and exercise and proper sleep (all of which affects stress as well)--stress depresses some of the same NT that meds work on.

Realistically, this means that an individual's depression is going to require an individual treatment. There is no silver bullet, and medication is a matter of trial an error.......self-experimentation, if you will, to find the right med at the right dose in the right combination with therapy and lifestyle changes. As a parent with a child that has ADHD, I'm quite familiar with this phenomenon... The goal of medication isn't to "cure" someone--we aren't talking about a germ to kill here, but to give them (pardon the overused analogy) a level playing field. Or...to go with my previous analogy, a better bucket.


This is a pretty decent introductory guide to the biology of depression: http://www.health.harvard.edu/newswe...depression.htm

Unfortunately, I think many of the problems with mental health come down to an inadequate understanding on part of the public on science in general--with regards to mental health, this results in a poor understanding of what constitutes quality research, of the limitations of current research (a scientific experiment or study can only look at a small number of variables--systems (whether its the human brain or an entire ecosystem) tend to be far more complex than that), of how that research applies to them (or how it doesn't necessairly apply to them), etc. Because we (the general public) have such a poor understanding of the subject, the support it recieves (erm...that it doesn't receive) in regards to policy (including regulations for facilities, funding for research and support of patients and their families, regulations allowing families of persons that are thought to be severly impaired by their mental disorder to get them care, etc) is rediculous.

[B. de Corbin]

Re: about Depression

While our lack of understanding is understandable, a few minutes of time spent with WebMD will get a layperson a pretty good layperson's understanding of the complexities of depression.

The skill to do simple research is useful - you don't need to be an MD or researcher to understand the complexities of most things, although to navigate those complexities and arrive at meaningful conclusions a bit of education helps.

There'd be a lot less goofy in the world if people bothered to do a bit of research on those issues they think of themselves as "expert" on.

[Roknrol]

Re: about Depression

WebMD can help explain, but it cannot help understand.

This is my fundamental problem with therapists/psychiatrists to begin with...it's a lack of understanding. If we understood the brain better we could probably make them understand, but conversely, if we knew the brain better we probably wouldn't need them.

[nbdy]

Re: about Depression

That's just it, though, Thal, the meds are not typically dispensed as merely treating a symptom while continuing to seek the cause. That's why people stay on them for years and years. It's the same way statins are treated as the answer for elevated cholesterol, which is a symptom rather than a disease -- just bring the cholesterol down and don't bother figuring out why it was high in the first place. The rest of the person's life is on pills. I have another friend who is trying to get past 20 years of medication, and it has been a tough haul. Years of slowly reducing dosage, and she is not in the clear yet.

As far as my 'gone' friend's care: it was some of the best available anywhere. She had multiple advanced degrees (PhD in chemistry among them, so she understood what she was taking) and had the best doctors available in the Chapel Hill area. Trust me, the pills were the entirety of her treatment until they ran out of chemicals to try. There was no plan B and I have not seen the conversation change since.

I totally get that each brain is unique, and somewhere up under all the protocols I understand that every psychiatrist knows this, too, but it is a reality that does not seem to mesh well with the practice of modern medicine. I know that I am biased by personal experiences, and I know that there are at least as many who recover as who don't, but that could be attributable to any number of other factors.

I guess I will be able to do a 100% buy-in to the chemical imbalance theory when they have a reliable lab test for at least one type of depression. Something that is completely biological should be empirically observable. Even then, though, it is as easily correlation as causation, and the multi-billion dollar question is: why is something out of balance?

[harryj3105]

Re: about Depression

I would defiantly try some meditation and keep yourself busy as this can take your mind off of your underlying thoughts. Blessed Be

[midgnostic]

Re: about Depression

treating a symptom while continuing to seek the cause

I'm sure it can be proved that people with more sadness have less seratonin but what does it mean? Depression may be a side-effect of the purpose seratonically-challenged brains are adapted to. It may be necessary for them to be less easily pleased in the first instance in order to seek environments which are more conducive to their vocation

[eternal sovernity]

Re: about Depression

I like depression in a way. It is a state of mercy that promotes survival.